Opening Snap and Second Heart Sound

An opening snap occurring early in diastole along with a single second heart sound can mimic a split second heart sound. An opening snap is caused by thickened valve leaflets. When they open, it produces a snapping sound. The more severe the thickening the earlier in diastole the opening snap occurs. In this example you are hearing an opening snap, which occurs 75 milliseconds after the start of the second heart sound.

Opening Snap and Second Heart Sound Audio

Opening Snap and Second Heart Sound auscultation sound from lesson

Patient Sounds

Opening Snap and Second Heart Sound patient recording

Half Speed Patient Sounds

Opening Snap and Second Heart Sound half speed

Technique

The patient's position should be supine.

Auscultation Tips

Diastole:Snap early in diastole, higher-pitch than S2

Sound Wave

Observe Cardiac Animation

An opening snap is caused by thickened valve leaflets. When they open it, produces a snapping sound. The more severe the thickening the earlier in diastole the opening snap occurs. In this example you are hearing an opening snap which occurs 75 milliseconds after the start of the second heart sound.

Authors and Sources

Authors and Reviewers

ECG heart rhythm modules: Thomas O'Brien.
ECG monitor simulation developer: Steve Collmann
12 Lead Course: Dr. Michael Mazzini, MD.
Spanish language ECG: Breena R. Taira, MD, MPH
Medical review: Dr. Jonathan Keroes, MD
Medical review: Dr. Pedro Azevedo, MD, Cardiology
Last Update: 11/8/2021

Sources

Electrocardiography for Healthcare Professionals, 6th Edition Kathryn Booth and Thomas O'Brien
ISBN10: 1265013470, ISBN13: 9781265013479
McGraw Hill, 2023
Rapid Interpretation of EKG's, Sixth Edition
Dale Dublin
Cover Publishing Company
EKG Reference Guide
EKG.Academy
12 Lead EKG for Nurses: Simple Steps to Interpret Rhythms, Arrhythmias, Blocks, Hypertrophy, Infarcts, & Cardiac Drugs
Aaron Reed
Create Space Independent Publishing
Heart Sounds and Murmurs: A Practical Guide with Audio CD-ROM 3rd Edition
Elsevier-Health Sciences Division
Barbara A. Erickson, PhD, RN, CCRN
The Virtual Cardiac Patient: A Multimedia Guide to Heart Sounds, Murmurs, EKG Jonathan Keroes, David Lieberman
Publisher: Lippincott Williams & Wilkin)
ISBN-10: 0781784425; ISBN-13: 978-0781784429
Project Semilla, UCLA Emergency Medicine, EKG Training Breena R. Taira, MD, MPH
ECG Reference Guide
PracticalClinicalSkills.com

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